Surgical Instructions

After Wisdom Tooth Removal

The removal of impacted teeth is a major surgical procedure and should be treated accordingly.  Good post-operative care is very important for normal wound healing. Unnecessary complications such as pain, infection and swelling can be minimized by following the instructions carefully. Our goal is to have you return to your normal activities as soon as is possible following your procedure. This requires great cooperation from you.

Immediately Following Surgery/IV General Anesthesia

  1. The gauze pads placed over the surgical areas should be kept in place for 30 - 60 and then changed as needed until the bleeding has almost stopped.
  2. Only gentle mouth rinsing should be done on the day of surgery. Avoid touching or disturbing the wound area on the day of surgery for doing so may initiate bleeding which will prolong the necessary use of the gauze pads.
  3. Take the prescribed pain medications as soon as you begin to feel discomfort or as the local anesthesia begins to wear off. Take your antibiotics as prescribed.
  4. Caution: If you suddenly sit up or stand from a lying position you may become dizzy and may even faint. If you are lying down following surgery, make sure you sit for one minute before standing. ALL PATIENTS - including males - should sit on the toilet to use the bathroom after surgery. Restrict your activities on the day of surgery and resume normal activities 3 - 7 days after surgery. Only resume any/all of your activities as you are able to do so - e.g. without jaw pain, weakness, fatigue, etc. Go slowly and “test the waters” before resuming full activities. Please call the office if you have any concerns.
  5. Place ice packs to the sides of your face - 20 - 30 minutes at a time - where the surgery was performed for 1 - 3 days as you desire. This will greatly help reduce jaw swelling.

Post-Op Checkup

Dr. Perry or his staff will phone you at home on the evening of your surgery or the next day. This enables him to ward off any problems which may arise following surgery. He is available at all times by phone 937-294-1980; if no answer there, call his cell ph. 937-620-9956. You will return for a post-op appointment within 1 - 2 weeks following your surgery. The wounds will be examined and irrigated at this time and any necessary additional instructions will be given as well.     

Bleeding

Wound bleeding is to be expected for 2 - 18 hours after surgery. Mild bleeding, oozing, or reddish-pink saliva commonly occurs as the bleeding diminishes. Excessive bleeding may be controlled by gentle rinsing, wiping any extruded clots from your wound(s) with a gauze and placing a gauze pad over the area with firm biting pressure for 30 - 60 minutes. Repeat as necessary. Constant removal of the gauze (every 5 - 10 minutes) to check for bleeding will promote more bleeding. If bleeding continues, place a moistened tea bag covered by a gauze pad directly on the wound for  30 - 60 minutes. The tannic acid in the tea bag helps promote clotting. Another “trick” involves rinsing out a fresh gauze pad with hot tap water, wringing it out and placing it over the wound. The heat promotes the clotting reaction as well. Please call the office or Dr. Perry if bleeding cannot be controlled.

Swelling and Jaw Stiffness

Post-operative swelling is a natural body response to surgery and varies greatly from patient to patient. It may peak in 2 - 3 days and may persist for 5 - 7 days. With the removal of third molars (wisdom teeth), considerable jaw stiffness may occur with very limited jaw opening. This is especially true with the removal of the lower third molars. It may persist for up to 3 weeks following surgery and will slowly subside. Chewing gum after the first week may help regain normal  jaw opening. TMJ pain or soreness may occur after the removal of difficult impacted third molars. This is due to the placement of a mouth prop for surgical access and the length of time needed to complete this difficult surgery with one’s mouth propped open. It should resolve with limited jaw opening, a soft diet, and prolonged use of Ibuprofen - an anti-inflammatory pain medication. Please advise the office if you have prolonged  symptoms.

Pain

For mild to moderate pain - take one or two tablets of Tylenol or Extra Strength Tylenol every 3 - 4 hours - OR -  take  2 - 4 Ibuprofen (Advil) 200 mg tablets every 4 - 8 hours.

For severe pain - take the narcotic tablets prescribed as directed - 1 - 2 tablets every 3 - 4 hours as needed for pain. Do not take Tylenol in addition to the narcotic medication as there is Tylenol in the narcotic medication.  The prescribed pain medicine may make you groggy and will slow your reflexes. Do not drive an automobile, operate any machinery or drink any alcoholic beverages while taking narcotic medication. Pain or discomfort following surgery should subside daily. If pain either persists or increases, please call the office or Dr. Perry.

Diet

After general anesthetic or I.V. sedation, liquids should be initially taken. Avoid the use of straws and drink from a glass. The sucking action of straws can cause more bleeding  and may dislodge the blood clot(s) from the wounds. Cool or cold liquids and soft foods are best tolerated following surgery. You may resume eating soft foods by chewing slowly in areas away from the surgical sites. A high calorie, high protein diet is very important. Ensure liquid dietary supplement is helpful. Drink at least a total of 2 quarts of liquid daily for the first 2 - 4 days. Inadequate oral fluid intake can cause you to develop a fever. You should be voiding (urinating) 5 - 6 times per day. Urine should be pale yellow and almost clear. Dark urine is a sign of dehydration - a dangerous post-operative condition. You may eat anything which doesn’t cause pain or bleeding as you recover. Avoid eating popcorn for 6 weeks after surgery as it may cause a delayed infection - especially in the wounds of the lower jaw.

Oral Hygiene/Wound Care

You may brush your teeth and rinse gently on the night of surgery. The day after surgery you should begin rinsing at least 4 times a day (after meals and before bedtime) with a cup of warm water mixed with ¼ tsp. of salt. Continue the warm salt water rinses until all soreness is gone. This may take 2 - 3 weeks. You may begin wound irrigation of the sockets (especially the lowers) on the 4th - 5th post-op day. Fill the curved tip syringe with a mixture of equal parts warm water and your favorite mouthwash - place the tip half way down into the wound and flush gently. Repeat at each site and perform this 4 times per day - after meals and before bedtime. Once the sockets have completely healed over, you may discontinue its use. Failing to properly irrigate the wounds greatly increases your risk of an infection of the socket and jaw/neck region.

Bruising

In some cases, bruising/discoloration of the skin will occur after surgery. It may appear as shades of black, blue, green, or yellow discoloration and is due to bleeding from the surgery sites beneath the tissues. This is a normal post-operative occurrence which arises 2-3 days post-operatively and may last for 7 - 10 days. Moist heat applied to the area may help accelerate the disappearance of the bruising.

Antibiotics

Take your antibiotics as directed. Antibiotics are given to help prevent infection and the prescription should be taken until it is gone. Do not refill your prescription unless directed to do so by Dr. Perry. Discontinue antibiotic usage in the event of a rash or other unfavorable reaction and call the office for further instructions. If you experience increased jaw or facial swelling, redness, difficulty with swallowing or opening, fever or pain, please notify our office at once. Delaying treatment of a deep jaw/neck infection can result in a prolonged hospitalization.

Nausea and Vomitting

In the event of nausea and/or vomitting following surgery, do not take anything by mouth for at least an hour - including the prescribed medicines. You should then sip/drink Gatorade or clear liquids (water, 7-Up or Sprite) as you are able. You should fill your prescription for Phenergan suppositories and place rectally with a finger cot which the pharmacist will provide. When the nausea subsides you may resume taking oral fluids and your diet as you are able. You may resume your prescribed medicines as soon as possible. If the nausea and vomitting are directly related to the narcotic pain pills, switch to Tylenol or Advil; if caused by the antibiotic, discontinue it and notify the office or Dr. Perry. If vomitting is unstoppable, notify Dr. Perry at once. A hospital admission is sometimes necessary for IV fluid replacement and anti-nausea therapy.

Sutures

Dr. Perry normally uses resorbable (self-dissolving) sutures. Please avoid disturbing these stitches with your tongue as doing so will cause the best tied sutures to unravel and to be lost prematurely. The sutures will normally last for 5-10 days before being lost. You may carefully trim any long ends with a scissor - or have someone you trust do the same - or call us and we’ll trim them for you. If you swallow any loose sutures, they will simply be digested. If they loosen and/or you remove them, just avoid disturbing the wound area. Sutures that are lost in the first 3 -4 days are not normally replaced. Continue gentle oral hygiene and wound care both before and after the sutures have come out.

Dry Sockets

Dry sockets occur when the blood clot in the lower jaw socket(s) dissolves or becomes dislodged prematurely. This causes a constant throbbing dull ache which is not relieved by pain medication. The onset of dry socket is anytime during the first 5 days following surgery. With this condition, one cannot sleep or be comfortable at all. If this occurs, please notify the office and you will be seen immediately. Treatment involves the gentle irrigation of the socket and the placement of a resorbable dressing with oil of cloves. This normally provides almost instantaneous relief which will last until the normal wound healing progresses. The healing of such wounds is normally delayed by ~ 1 week.

Delayed Socket Infections

Delayed Infections of third molar sites may arise 1 - 2 months or more after surgery. They are characterized by a sudden onset of pain, swelling, jaw stiffness, pus, and redness. These sometimes will respond to simple irrigation and antibiotic therapy. More often they require surgical curettage with local anesthesia in addition to specific antibiotic therapy. Ignoring such an infection can result in a severe bone infection (osteomyelitis) which requires a referral to an Infectious Disease Specialist. They normally treat this condition with a central IV catheter (PICC) and IV antibiotics.

Other Expectations/Complications

  1. If numbness of the lip, chin, or tongue occurs, please advise the office or Dr. Perry.  As was discussed before surgery, this condition is usually temporary in nature. You should be aware that if your lip or tongue is numb, you must be cautious to avoid biting either the lip or tongue while chewing.  Dr. Perry will carefully evaluate this condition and advise you of it’s severity and it’s likely longterm outcome. Most of these nerve bruises resolve in a few weeks or months - some do not. Dr. Perry will gladly answer any questions which you may have regarding such a condition.
  2. Slight elevation of temperature can arise immediately following surgery. If the elevated temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever. Good oral fluid intake is very essential to reduce a fever.
  3. You may experience redness and cracking of the corners of your mouth after surgery.  Your lips should be kept moist with an ointment or cream such as Vaseline, Chap Sticks, Burt’s Bees, or aloe vera.
  4. A sore throat and/or pain with swallowing may occur after surgery.  These symptoms will normally subside in 5 - 7 days.
  5. The pain and swelling should gradually subside each day following surgery. If your post-operative pain or swelling increases, please call the office for instructions.
  6. There may be a socket/cavity that persists where the tooth was removed. This cavity will quickly heal with new tissue in 1 - 3 weeks.  You may irrigate this daily for the best wound healing - beginning 4 - 5 days after surgery

If you have any concerns or questions that are not addressed in your post operative instructions (blue sheet) or in this website, please direct them to our staff and to Dr. Perry. Your case is individual, and no two patients are alike. Please do not seek or accept the well intended advice of friends or family. Our entire team that provides your service has many decades of experience. Thus, we appreciate being able to direct your care in the most efficient and effective way possible.